ICU护士应用肺部超声筛查呼吸困难的可行性研究

Feasibility study of ICU nurses screening the causes of dyspnea in severe patients by using pulmonary ultrasound

目的评估ICU护士应用肺部超声检查对重症患者呼吸困难原因筛查的可行性，并探讨其对护理决策的影响。方法重症医学科护士经过16h的肺部超声培训，对急性呼吸衰竭患者进行床旁肺脏超声检查，对患者肺部情况进行评估，筛查是否有胸腔积液、肺不张肺实变等；由通过国际重症超声联盟组织认证的ICU医师重复检查，评价ICU护士解释的准确性。结果51例患者共510个肺部超声检查点。与医生相比，ICU护士正确诠释了472个超声征象，占92．53％。ICU护士通过超声检查发现胸腔积液敏感度为86．7％，特异度为95．2％，诊断准确率为90．2％，Youden指数81．9％；通过超声检查发现肺不张肺实变敏感度为92．1％，特异度为92．3％，诊断准确率为92．2％，Youden指数84．4％。结论经过规范化培训的ICU护士可以正确解读肺部超声征象，对胸腔积液、肺不张／肺实变的筛查具有良好的诊断价值；为优化胸部物理治疗方案提供了依据。

Objective To evaluate the feasibility of ICU nurse-performed lung ultrasound in screening the reason of dyspnea in ICU patients, and to explore the effect on nursing decisions. Methods ICU nurses trained on lung ultrasound with 16 hours performed point-of-care lung ultrasound in patient with acute respiratory failure to assess the condition of the patient＇s lungs and screen for pleural effusion, atelectasis/lung consolidation. Etc; Repeated examinations by ICU physicians accredited by the International Critical Ultrasound Alliance to evaluate the accuracy of ICU nurse interpretation. Results A total of 510 lung ultrasonographic examinations were performed in 51 patients. Compared with physicians, ICU nurses correctly interpreted 472 ultrasound signs, accounting for 92.53%. ICU nurses found that the sensitivity of the pleural effusion was 86.7%, the specificity was 95.2%, and the diagnostic accuracy rate was 90.2%, and Youden index was 81.9%. The ultrasonography revealed a sensitivity of 92.1% for atelectic/pulmonary consolidation and a specificity of 92.3. %, the diagnostic accuracy rate was 92.2% and Youden index was 84.4%. Conclusion ICU nurses who have undergone standardized training can correctly interpret lung ultrasound signs and have good diagnostic value for screening of pteural effusions and atelectasis/lung consolidation; they provide the basis for optimization of chest physiotherapy progTams.